Not all brain aneurysms require surgery. Some require no treatment at all, while it may be possible to treat other aneurysms with medications, lifestyle changes, or rehabilitative therapy.

A brain aneurysm, also known as a cerebral aneurysm, is when a weakened blood vessel wall in the brain bulges due to pressure from blood passing through it.

If an aneurysm is at risk of rupturing, doctors may recommend surgery. However, surgery is not suitable for everyone — it tends to yield more positive outcomes for younger people with no overall health issues. This is because these individuals are better able to recover quickly and heal fully.

This article discusses whether surgery is necessary to treat a brain aneurysm, what other treatments are available, the best treatments for brain aneurysms, and when to seek medical care.

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Surgery is not always necessary for a brain aneurysm.

A doctor may recommend surgical treatment if there is a risk of the aneurysm bursting.

The type of treatment may depend on numerous factors, such as:

  • the size, shape, or position of the aneurysm
  • the person’s personal and family medical history
  • the person’s overall health

In some cases, individuals may find other nonsurgical treatments more suitable. They may not require treatment if they do not have any symptoms or have a low risk of complications.

A person’s doctor can advise on whether they recommend surgery or other treatments for a brain aneurysm.

Learn about brain aneurysm surgery scars.

In some cases, a person may require treatment for a brain aneurysm that does not involve open surgical intervention.

Other treatments for a burst brain aneurysm focus on managing symptoms and minimizing complications.

Catheter treatment (endovascular coiling)

Catheter treatment — which medical professionals may also sometimes call endovascular coiling — does not involve open surgery, although it is still a surgical procedure. During catheter treatment, the person undergoing the procedure will receive an anesthetic, usually a general anesthetic. The surgical team will then insert a catheter into an artery in the groin. They will then move it into the blood vessel that is the site of the aneurysm.

With this in place, the surgical team can then thread tiny platinum coils through the catheter to place them in the aneurysm. The blood inside the aneurysm will clot because of the coils. Clotting prevents more blood from entering into the aneurysm.

Sometimes, a surgical team may also insert tiny tubes called stents to hold the blood vessel open so that blood can then flow past the aneurysm through the stents.

People typically undergo catheter treatment if their treatment team believes surgery would be too risky, such as when a person has a preexisting cardiovascular condition.

Shunt implantation

A shunt is a device that surgeons implant into the brain after an aneurysm bursts. They may do this if the buildup of cerebrospinal fluid, which circulates within the brain and spinal cord, creates harmful pressure on the surrounding brain tissue.

The shunt helps relieve this pressure by funneling cerebrospinal fluid from the brain to elsewhere in the body.

Antiseizure drugs

Doctors may prescribe antiseizure drugs, or anticonvulsants, to prevent seizures relating to a burst aneurysm.

Calcium channel blockers

Calcium channel blockers can help lower a person’s chances of experiencing stroke by vasospasm.

Rehabilitative therapy

Individuals who have experienced a subarachnoid hemorrhage often need rehabilitative therapy to help them regain lost function and learn to function with any permanent disability.

Types of therapy a doctor may recommend include:

  • speech therapy
  • physical therapy
  • occupational therapy

Lifestyle changes

A doctor may recommend that a person takes steps to lower the risk of their aneurysm rupturing, such as:

  • controlling their blood pressure
  • quitting smoking, if applicable
  • avoiding alcohol
  • avoiding using stimulant recreational drugs

The best choice of treatment for an individual depends on several factors, such as:

  • the location of the aneurysm
  • the size and shape of the aneurysm
  • the person’s overall health and age

For many people, avoiding surgery will be desirable, as this minimizes potential complications. According to a 2021 Japanese research paper, the movement from invasive mechanical interventions to drug-centered approaches represents a “natural evolution” in treatment.

Not all brain aneurysms require treatment.

If a person has no symptoms and a low risk of rupture or complications, they may not need medical treatment. However, if this is the case, experts still recommend a person have a checkup every 1–3 years.

If there is a high risk of the aneurysm bleeding, doctors will typically recommend treatment.

Often, a person may have a cerebral aneurysm without even realizing it, as they have no symptoms. However, if an aneurysm ruptures or leaks, this can cause serious complications.

Therefore, anyone who experiences a sudden, severe headache should contact a doctor urgently, particularly if their headache occurs alongside symptoms such as:

  • vomiting
  • nausea
  • double vision
  • light sensitivity
  • a stiff neck
  • seizures
  • losing consciousness
  • cardiac arrest

In cases of emergency, a doctor can administer a medication called nimodipine, which reduces the likelihood of cerebral ischemia. This refers to a severe disruption to the brain’s blood supply.

Not all brain aneurysms require surgery — some require no treatment at all.

The optimal treatment for a person’s aneurysm will depend on factors including the size, shape, and location of the aneurysm and the person’s age and overall health status.

Other treatments for aneurysm include medications, implanting a shunt, lifestyle changes, and rehabilitative therapy. A person’s doctor can advise on what treatments they recommend and whether they feel surgery is necessary.